Psoriasis is a chronic relapsing papulosquamous skin disease which can also affect nails. Nail involvement resembles a fungus infection with stippling, separation of the distal margin, nail loss, scales under the nail plate, thickening and discoloration and is seen in anywhere from ten to fifty percent of psoriasis patients.
While there are a limited number of effective anti-psoriasis agents, it is far more difficult to treat psoriasis of the nails than that of the skin.
Treatment of psoriasis (skin) can include daily removal of the scales by applying soap and water and scrubbing gently with a soft brush, followed by the application of a keratolytic ointment.
Topical steroids, particularly 0.01 to 0.025% of fluocinolene acetonide, 0.25% fluorandrenolide and 0.05% triamcinolene acetonide creams have replaced many previous local treatments. The topical steroids are most effective if covered with a polyethylene film, Saran Wrap.TM. or HandiWrap.RTM., which preferably are sealed with tape. Thin polyethylene gloves are used for treating the hands and fingers.
Another method involving topical steroids are the use of an inconspicuous, transparent, plastic surgical tape containing fluorandrenolide, Cordran.RTM. tape sold by Dista Products Company, Division of Eli Lilly and Company, Indianapolis, Indiana 46206.
Generally speaking, while there are methods which are effective in treating psoriasis of the skin, attempts to treat nail involvement have failed miserably. Topically applied steroids are generally without effect.
I have found that excellent results are obtained when the topical steroid is applied to the affected nails in nail polish.